Provider Demographics
NPI:1487723466
Name:MICKENS, SONYA SIMMONS (RRT)
Entity type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:SIMMONS
Last Name:MICKENS
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 AMBASSADOR DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3401
Mailing Address - Country:US
Mailing Address - Phone:813-882-0279
Mailing Address - Fax:727-398-9549
Practice Address - Street 1:10000 BAY PINES BLVD
Practice Address - Street 2:BAY PINES VA HEALTHCARE
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT0003156227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered